Long term efficacy of Omalizumab for patients with refractory chronic urticaria and angioedema

Abstract

Omalizumab was approved for the treatment of refractory chronic urticaria and angioedema (CUA) since 2014. The exact mechanism of how omalizumab works in CUA has not been fully elucidated. Short-term efficacy of omalizumab for patients with refractory CUA has been shown in a number of randomized trails. However the duration of the therapy and the long term efficacy remains unclear. Analyzing a total 90 objects with refractory CUA at our center received omalizumab 300mg every 2-6 weeks between 2013 and 2016. Stratifying the factors affecting the long term outcome of Omalizumab therapy for refractory CUA. Among the 90 patients, 59 (65.56%) failed Cyclosporine, 20 (22.22%) failed Dapsone and 16 (17.78%) failed Hydroxychloroquine therapy in addition to antihistamine therapy. 14 (15.56%) didn’t experience significant clinical improvement after receiving at least 3 treatments. 3 (3.33%) experienced worsening symptoms and stopped the treatment. By completing at least 12 month treatment, 29 (32.22%) were able to discontinue Omalizumab. However, of the 29 patients, 18 experienced flare of urticaria and/or angioedema symptoms after discontinuing Omalizumab, ranging from 6 weeks to 36 weeks. Only 8 (8.89%) remain in complete remission more than 12 month without requiring maintenance treatment. Omalizumab is an effective therapy for patients with refractory CUA who failed other conventional therapy. A majority of patients has to continue the treatment in order to maintain remission.